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Retrievable inferior vena cava filters do not reduce the risk of recurrent pulmonary embolism (PE) or death in patients with PE, according to a study
published in JAMA.
The study showed no significant difference in outcomes between patients who received anticoagulation in conjunction with an inferior vena cava
filter and patients who received anticoagulant therapy alone.
Studies have shown an increase in the placement of inferior vena cava filters over the past few decades. However, a lack of reliable data on the use of these filters has meant the benefit-risk ratio of using them in patients at risk of recurrent venous thromboembolism (VTE) is uncertain.
To gain more insight, Patrick Mismetti, MD, PhD, of the Centre Hospitalier Universitaire de Saint-Etienne in France, and his colleagues conducted a prospective study.
They enrolled hospitalized patients with acute, symptomatic PE associated with lower-limb vein thrombosis who had at least 1 criterion for severity. Patients were randomized to receive anticoagulation and a retrievable inferior vena cava filter (n=200) or anticoagulation alone (n=199).
The follow-up period was 6 months. Patients received full-dose anticoagulation for at least 6 months, and filter retrieval was planned at 3 months from placement.
Filters were successfully inserted in 193 patients. Filter retrieval was successful in 153 of the 164 patients in whom retrieval was attempted.
In the anticoagulant-only group, 6 patients ultimately received a filter, 4 because they were undergoing surgery and needed to stop anticoagulation, and 2 because of bleeding complications.
By 3 months, 6 patients (3.0%) had recurrent PE in the filter group, as did 3 patients (1.5%) in the anticoagulant-only group (P=0.50). All episodes in the filter group and 2 in the anticoagulant group were fatal.
The researchers observed 1 additional PE recurrence in each treatment group between 3 and 6 months (P=0.54). And 3 patients developed filter thrombosis.
At 3 months, there was no significant difference between the 2 treatment groups with regard to recurrent deep vein thrombosis (P>0.99), recurrent VTE (P=0.36), major bleeding (P=0.63), or death from any cause (P=0.55).
At 6 months, there was no significant difference between the treatment groups with regard to recurrent deep vein thrombosis (P>0.99), recurrent VTE (P=0.59), major bleeding (P=0.69), or death from any cause (P=0.29).
The main cause of death in both treatment groups was cancer.
The researchers noted that the availability of retrievable inferior vena cava filters has probably contributed to their increased use for managing acute VTE, including their use in addition to full-dose anticoagulant therapy in patients with PE, a large clot burden, a poor cardiopulmonary reserve, or a suspected increased risk for recurrence, as advocated by several guidelines.
However, the team said the results of this study do not support the use of these filters in patients who can be treated with anticoagulation.
